| The Bougainvilla House, Inc. | |
|
1727 Se 4th Ave Fort Lauderdale FL 33316-2515 | |
| (954) 764-7337 | |
| (954) 764-6283 |
| Full Name | The Bougainvilla House, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1727 Se 4th Ave, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Cici Kelly (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9547647337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Bougainvilla House, Inc. 1721 Se 4th Ave Fort Lauderdale FL 33316-2515 Ph: (954) 764-7337 | The Bougainvilla House, Inc. 1727 Se 4th Ave Fort Lauderdale FL 33316-2515 Ph: (954) 764-7337 |
| NPI Number | 1962835488 |
|---|---|
| Provider Enumeration Date | 08/20/2013 |
| Last Update Date | 02/04/2021 |
| Certification Date | 02/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962835488 | NPI | - | NPPES |
| 013497000 | Medicaid | FL |
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